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Publisher: Elsevier   (Total: 3182 journals)

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Showing 1 - 200 of 3182 Journals sorted alphabetically
Academic Pediatrics     Hybrid Journal   (Followers: 39, SJR: 1.655, CiteScore: 2)
Academic Radiology     Hybrid Journal   (Followers: 26, SJR: 1.015, CiteScore: 2)
Accident Analysis & Prevention     Partially Free   (Followers: 105, SJR: 1.462, CiteScore: 3)
Accounting Forum     Hybrid Journal   (Followers: 28, SJR: 0.932, CiteScore: 2)
Accounting, Organizations and Society     Hybrid Journal   (Followers: 42, SJR: 1.771, CiteScore: 3)
Achievements in the Life Sciences     Open Access   (Followers: 7)
Acta Anaesthesiologica Taiwanica     Open Access   (Followers: 6)
Acta Astronautica     Hybrid Journal   (Followers: 441, SJR: 0.758, CiteScore: 2)
Acta Automatica Sinica     Full-text available via subscription   (Followers: 2)
Acta Biomaterialia     Hybrid Journal   (Followers: 29, SJR: 1.967, CiteScore: 7)
Acta Colombiana de Cuidado Intensivo     Full-text available via subscription   (Followers: 3)
Acta de Investigación Psicológica     Open Access   (Followers: 3)
Acta Ecologica Sinica     Open Access   (Followers: 11, SJR: 0.18, CiteScore: 1)
Acta Histochemica     Hybrid Journal   (Followers: 5, SJR: 0.661, CiteScore: 2)
Acta Materialia     Hybrid Journal   (Followers: 318, SJR: 3.263, CiteScore: 6)
Acta Mathematica Scientia     Full-text available via subscription   (Followers: 5, SJR: 0.504, CiteScore: 1)
Acta Mechanica Solida Sinica     Full-text available via subscription   (Followers: 9, SJR: 0.542, CiteScore: 1)
Acta Oecologica     Hybrid Journal   (Followers: 12, SJR: 0.834, CiteScore: 2)
Acta Otorrinolaringologica (English Edition)     Full-text available via subscription  
Acta Otorrinolaringológica Española     Full-text available via subscription   (Followers: 2, SJR: 0.307, CiteScore: 0)
Acta Pharmaceutica Sinica B     Open Access   (Followers: 2, SJR: 1.793, CiteScore: 6)
Acta Poética     Open Access   (Followers: 4, SJR: 0.101, CiteScore: 0)
Acta Psychologica     Hybrid Journal   (Followers: 26, SJR: 1.331, CiteScore: 2)
Acta Sociológica     Open Access   (Followers: 1)
Acta Tropica     Hybrid Journal   (Followers: 6, SJR: 1.052, CiteScore: 2)
Acta Urológica Portuguesa     Open Access  
Actas Dermo-Sifiliograficas     Full-text available via subscription   (Followers: 3, SJR: 0.374, CiteScore: 1)
Actas Dermo-Sifiliográficas (English Edition)     Full-text available via subscription   (Followers: 2)
Actas Urológicas Españolas     Full-text available via subscription   (Followers: 3, SJR: 0.344, CiteScore: 1)
Actas Urológicas Españolas (English Edition)     Full-text available via subscription   (Followers: 1)
Actualites Pharmaceutiques     Full-text available via subscription   (Followers: 7, SJR: 0.19, CiteScore: 0)
Actualites Pharmaceutiques Hospitalieres     Full-text available via subscription   (Followers: 3)
Acupuncture and Related Therapies     Hybrid Journal   (Followers: 8)
Acute Pain     Full-text available via subscription   (Followers: 15, SJR: 2.671, CiteScore: 5)
Ad Hoc Networks     Hybrid Journal   (Followers: 11, SJR: 0.53, CiteScore: 4)
Addictive Behaviors     Hybrid Journal   (Followers: 18, SJR: 1.29, CiteScore: 3)
Addictive Behaviors Reports     Open Access   (Followers: 9, SJR: 0.755, CiteScore: 2)
Additive Manufacturing     Hybrid Journal   (Followers: 11, SJR: 2.611, CiteScore: 8)
Additives for Polymers     Full-text available via subscription   (Followers: 23)
Advanced Drug Delivery Reviews     Hybrid Journal   (Followers: 187, SJR: 4.09, CiteScore: 13)
Advanced Engineering Informatics     Hybrid Journal   (Followers: 12, SJR: 1.167, CiteScore: 4)
Advanced Powder Technology     Hybrid Journal   (Followers: 17, SJR: 0.694, CiteScore: 3)
Advances in Accounting     Hybrid Journal   (Followers: 9, SJR: 0.277, CiteScore: 1)
Advances in Agronomy     Full-text available via subscription   (Followers: 17, SJR: 2.384, CiteScore: 5)
Advances in Anesthesia     Full-text available via subscription   (Followers: 30, SJR: 0.126, CiteScore: 0)
Advances in Antiviral Drug Design     Full-text available via subscription   (Followers: 2)
Advances in Applied Mathematics     Full-text available via subscription   (Followers: 12, SJR: 0.992, CiteScore: 1)
Advances in Applied Mechanics     Full-text available via subscription   (Followers: 12, SJR: 1.551, CiteScore: 4)
Advances in Applied Microbiology     Full-text available via subscription   (Followers: 24, SJR: 2.089, CiteScore: 5)
Advances In Atomic, Molecular, and Optical Physics     Full-text available via subscription   (Followers: 15, SJR: 0.572, CiteScore: 2)
Advances in Biological Regulation     Hybrid Journal   (Followers: 4, SJR: 2.61, CiteScore: 7)
Advances in Botanical Research     Full-text available via subscription   (Followers: 2, SJR: 0.686, CiteScore: 2)
Advances in Cancer Research     Full-text available via subscription   (Followers: 34, SJR: 3.043, CiteScore: 6)
Advances in Carbohydrate Chemistry and Biochemistry     Full-text available via subscription   (Followers: 9, SJR: 1.453, CiteScore: 2)
Advances in Catalysis     Full-text available via subscription   (Followers: 5, SJR: 1.992, CiteScore: 5)
Advances in Cell Aging and Gerontology     Full-text available via subscription   (Followers: 5)
Advances in Cellular and Molecular Biology of Membranes and Organelles     Full-text available via subscription   (Followers: 14)
Advances in Chemical Engineering     Full-text available via subscription   (Followers: 29, SJR: 0.156, CiteScore: 1)
Advances in Child Development and Behavior     Full-text available via subscription   (Followers: 11, SJR: 0.713, CiteScore: 1)
Advances in Chronic Kidney Disease     Full-text available via subscription   (Followers: 10, SJR: 1.316, CiteScore: 2)
Advances in Clinical Chemistry     Full-text available via subscription   (Followers: 26, SJR: 1.562, CiteScore: 3)
Advances in Colloid and Interface Science     Full-text available via subscription   (Followers: 20, SJR: 1.977, CiteScore: 8)
Advances in Computers     Full-text available via subscription   (Followers: 14, SJR: 0.205, CiteScore: 1)
Advances in Dermatology     Full-text available via subscription   (Followers: 15)
Advances in Developmental Biology     Full-text available via subscription   (Followers: 13)
Advances in Digestive Medicine     Open Access   (Followers: 12)
Advances in DNA Sequence-Specific Agents     Full-text available via subscription   (Followers: 7)
Advances in Drug Research     Full-text available via subscription   (Followers: 26)
Advances in Ecological Research     Full-text available via subscription   (Followers: 44, SJR: 2.524, CiteScore: 4)
Advances in Engineering Software     Hybrid Journal   (Followers: 29, SJR: 1.159, CiteScore: 4)
Advances in Experimental Biology     Full-text available via subscription   (Followers: 8)
Advances in Experimental Social Psychology     Full-text available via subscription   (Followers: 52, SJR: 5.39, CiteScore: 8)
Advances in Exploration Geophysics     Full-text available via subscription   (Followers: 1)
Advances in Fluorine Science     Full-text available via subscription   (Followers: 9)
Advances in Food and Nutrition Research     Full-text available via subscription   (Followers: 67, SJR: 0.591, CiteScore: 2)
Advances in Fuel Cells     Full-text available via subscription   (Followers: 17)
Advances in Genetics     Full-text available via subscription   (Followers: 21, SJR: 1.354, CiteScore: 4)
Advances in Genome Biology     Full-text available via subscription   (Followers: 11, SJR: 12.74, CiteScore: 13)
Advances in Geophysics     Full-text available via subscription   (Followers: 7, SJR: 1.193, CiteScore: 3)
Advances in Heat Transfer     Full-text available via subscription   (Followers: 26, SJR: 0.368, CiteScore: 1)
Advances in Heterocyclic Chemistry     Full-text available via subscription   (Followers: 11, SJR: 0.749, CiteScore: 3)
Advances in Human Factors/Ergonomics     Full-text available via subscription   (Followers: 26)
Advances in Imaging and Electron Physics     Full-text available via subscription   (Followers: 3, SJR: 0.193, CiteScore: 0)
Advances in Immunology     Full-text available via subscription   (Followers: 37, SJR: 4.433, CiteScore: 6)
Advances in Inorganic Chemistry     Full-text available via subscription   (Followers: 10, SJR: 1.163, CiteScore: 2)
Advances in Insect Physiology     Full-text available via subscription   (Followers: 2, SJR: 1.938, CiteScore: 3)
Advances in Integrative Medicine     Hybrid Journal   (Followers: 6, SJR: 0.176, CiteScore: 0)
Advances in Intl. Accounting     Full-text available via subscription   (Followers: 3)
Advances in Life Course Research     Hybrid Journal   (Followers: 9, SJR: 0.682, CiteScore: 2)
Advances in Lipobiology     Full-text available via subscription   (Followers: 1)
Advances in Magnetic and Optical Resonance     Full-text available via subscription   (Followers: 8)
Advances in Marine Biology     Full-text available via subscription   (Followers: 21, SJR: 0.88, CiteScore: 2)
Advances in Mathematics     Full-text available via subscription   (Followers: 15, SJR: 3.027, CiteScore: 2)
Advances in Medical Sciences     Hybrid Journal   (Followers: 8, SJR: 0.694, CiteScore: 2)
Advances in Medicinal Chemistry     Full-text available via subscription   (Followers: 6)
Advances in Microbial Physiology     Full-text available via subscription   (Followers: 5, SJR: 1.158, CiteScore: 3)
Advances in Molecular and Cell Biology     Full-text available via subscription   (Followers: 25)
Advances in Molecular and Cellular Endocrinology     Full-text available via subscription   (Followers: 8)
Advances in Molecular Toxicology     Full-text available via subscription   (Followers: 7, SJR: 0.182, CiteScore: 0)
Advances in Nanoporous Materials     Full-text available via subscription   (Followers: 5)
Advances in Oncobiology     Full-text available via subscription   (Followers: 2)
Advances in Organ Biology     Full-text available via subscription   (Followers: 2)
Advances in Organometallic Chemistry     Full-text available via subscription   (Followers: 18, SJR: 1.875, CiteScore: 4)
Advances in Parallel Computing     Full-text available via subscription   (Followers: 7, SJR: 0.174, CiteScore: 0)
Advances in Parasitology     Full-text available via subscription   (Followers: 5, SJR: 1.579, CiteScore: 4)
Advances in Pediatrics     Full-text available via subscription   (Followers: 27, SJR: 0.461, CiteScore: 1)
Advances in Pharmaceutical Sciences     Full-text available via subscription   (Followers: 19)
Advances in Pharmacology     Full-text available via subscription   (Followers: 17, SJR: 1.536, CiteScore: 3)
Advances in Physical Organic Chemistry     Full-text available via subscription   (Followers: 9, SJR: 0.574, CiteScore: 1)
Advances in Phytomedicine     Full-text available via subscription  
Advances in Planar Lipid Bilayers and Liposomes     Full-text available via subscription   (Followers: 3, SJR: 0.109, CiteScore: 1)
Advances in Plant Biochemistry and Molecular Biology     Full-text available via subscription   (Followers: 10)
Advances in Plant Pathology     Full-text available via subscription   (Followers: 6)
Advances in Porous Media     Full-text available via subscription   (Followers: 5)
Advances in Protein Chemistry     Full-text available via subscription   (Followers: 19)
Advances in Protein Chemistry and Structural Biology     Full-text available via subscription   (Followers: 20, SJR: 0.791, CiteScore: 2)
Advances in Psychology     Full-text available via subscription   (Followers: 68)
Advances in Quantum Chemistry     Full-text available via subscription   (Followers: 6, SJR: 0.371, CiteScore: 1)
Advances in Radiation Oncology     Open Access   (Followers: 2, SJR: 0.263, CiteScore: 1)
Advances in Small Animal Medicine and Surgery     Hybrid Journal   (Followers: 3, SJR: 0.101, CiteScore: 0)
Advances in Space Biology and Medicine     Full-text available via subscription   (Followers: 6)
Advances in Space Research     Full-text available via subscription   (Followers: 424, SJR: 0.569, CiteScore: 2)
Advances in Structural Biology     Full-text available via subscription   (Followers: 5)
Advances in Surgery     Full-text available via subscription   (Followers: 13, SJR: 0.555, CiteScore: 2)
Advances in the Study of Behavior     Full-text available via subscription   (Followers: 38, SJR: 2.208, CiteScore: 4)
Advances in Veterinary Medicine     Full-text available via subscription   (Followers: 20)
Advances in Veterinary Science and Comparative Medicine     Full-text available via subscription   (Followers: 15)
Advances in Virus Research     Full-text available via subscription   (Followers: 6, SJR: 2.262, CiteScore: 5)
Advances in Water Resources     Hybrid Journal   (Followers: 54, SJR: 1.551, CiteScore: 3)
Aeolian Research     Hybrid Journal   (Followers: 6, SJR: 1.117, CiteScore: 3)
Aerospace Science and Technology     Hybrid Journal   (Followers: 387, SJR: 0.796, CiteScore: 3)
AEU - Intl. J. of Electronics and Communications     Hybrid Journal   (Followers: 8, SJR: 0.42, CiteScore: 2)
African J. of Emergency Medicine     Open Access   (Followers: 6, SJR: 0.296, CiteScore: 0)
Ageing Research Reviews     Hybrid Journal   (Followers: 12, SJR: 3.671, CiteScore: 9)
Aggression and Violent Behavior     Hybrid Journal   (Followers: 480, SJR: 1.238, CiteScore: 3)
Agri Gene     Hybrid Journal   (Followers: 1, SJR: 0.13, CiteScore: 0)
Agricultural and Forest Meteorology     Hybrid Journal   (Followers: 18, SJR: 1.818, CiteScore: 5)
Agricultural Systems     Hybrid Journal   (Followers: 31, SJR: 1.156, CiteScore: 4)
Agricultural Water Management     Hybrid Journal   (Followers: 44, SJR: 1.272, CiteScore: 3)
Agriculture and Agricultural Science Procedia     Open Access   (Followers: 4)
Agriculture and Natural Resources     Open Access   (Followers: 3)
Agriculture, Ecosystems & Environment     Hybrid Journal   (Followers: 58, SJR: 1.747, CiteScore: 4)
Ain Shams Engineering J.     Open Access   (Followers: 5, SJR: 0.589, CiteScore: 3)
Air Medical J.     Hybrid Journal   (Followers: 8, SJR: 0.26, CiteScore: 0)
AKCE Intl. J. of Graphs and Combinatorics     Open Access   (SJR: 0.19, CiteScore: 0)
Alcohol     Hybrid Journal   (Followers: 12, SJR: 1.153, CiteScore: 3)
Alcoholism and Drug Addiction     Open Access   (Followers: 12)
Alergologia Polska : Polish J. of Allergology     Full-text available via subscription   (Followers: 1)
Alexandria Engineering J.     Open Access   (Followers: 2, SJR: 0.604, CiteScore: 3)
Alexandria J. of Medicine     Open Access   (Followers: 1, SJR: 0.191, CiteScore: 1)
Algal Research     Partially Free   (Followers: 11, SJR: 1.142, CiteScore: 4)
Alkaloids: Chemical and Biological Perspectives     Full-text available via subscription   (Followers: 2)
Allergologia et Immunopathologia     Full-text available via subscription   (Followers: 1, SJR: 0.504, CiteScore: 1)
Allergology Intl.     Open Access   (Followers: 5, SJR: 1.148, CiteScore: 2)
Alpha Omegan     Full-text available via subscription   (SJR: 3.521, CiteScore: 6)
ALTER - European J. of Disability Research / Revue Européenne de Recherche sur le Handicap     Full-text available via subscription   (Followers: 11, SJR: 0.201, CiteScore: 1)
Alzheimer's & Dementia     Hybrid Journal   (Followers: 53, SJR: 4.66, CiteScore: 10)
Alzheimer's & Dementia: Diagnosis, Assessment & Disease Monitoring     Open Access   (Followers: 6, SJR: 1.796, CiteScore: 4)
Alzheimer's & Dementia: Translational Research & Clinical Interventions     Open Access   (Followers: 6, SJR: 1.108, CiteScore: 3)
Ambulatory Pediatrics     Hybrid Journal   (Followers: 5)
American Heart J.     Hybrid Journal   (Followers: 58, SJR: 3.267, CiteScore: 4)
American J. of Cardiology     Hybrid Journal   (Followers: 66, SJR: 1.93, CiteScore: 3)
American J. of Emergency Medicine     Hybrid Journal   (Followers: 47, SJR: 0.604, CiteScore: 1)
American J. of Geriatric Pharmacotherapy     Full-text available via subscription   (Followers: 13)
American J. of Geriatric Psychiatry     Hybrid Journal   (Followers: 14, SJR: 1.524, CiteScore: 3)
American J. of Human Genetics     Hybrid Journal   (Followers: 37, SJR: 7.45, CiteScore: 8)
American J. of Infection Control     Hybrid Journal   (Followers: 29, SJR: 1.062, CiteScore: 2)
American J. of Kidney Diseases     Hybrid Journal   (Followers: 36, SJR: 2.973, CiteScore: 4)
American J. of Medicine     Hybrid Journal   (Followers: 50)
American J. of Medicine Supplements     Full-text available via subscription   (Followers: 3, SJR: 1.967, CiteScore: 2)
American J. of Obstetrics and Gynecology     Hybrid Journal   (Followers: 265, SJR: 2.7, CiteScore: 4)
American J. of Ophthalmology     Hybrid Journal   (Followers: 66, SJR: 3.184, CiteScore: 4)
American J. of Ophthalmology Case Reports     Open Access   (Followers: 5, SJR: 0.265, CiteScore: 0)
American J. of Orthodontics and Dentofacial Orthopedics     Full-text available via subscription   (Followers: 6, SJR: 1.289, CiteScore: 1)
American J. of Otolaryngology     Hybrid Journal   (Followers: 25, SJR: 0.59, CiteScore: 1)
American J. of Pathology     Hybrid Journal   (Followers: 32, SJR: 2.139, CiteScore: 4)
American J. of Preventive Medicine     Hybrid Journal   (Followers: 28, SJR: 2.164, CiteScore: 4)
American J. of Surgery     Hybrid Journal   (Followers: 39, SJR: 1.141, CiteScore: 2)
American J. of the Medical Sciences     Hybrid Journal   (Followers: 12, SJR: 0.767, CiteScore: 1)
Ampersand : An Intl. J. of General and Applied Linguistics     Open Access   (Followers: 7)
Anaerobe     Hybrid Journal   (Followers: 4, SJR: 1.144, CiteScore: 3)
Anaesthesia & Intensive Care Medicine     Full-text available via subscription   (Followers: 67, SJR: 0.138, CiteScore: 0)
Anaesthesia Critical Care & Pain Medicine     Full-text available via subscription   (Followers: 25, SJR: 0.411, CiteScore: 1)
Anales de Cirugia Vascular     Full-text available via subscription   (Followers: 1)
Anales de Pediatría     Full-text available via subscription   (Followers: 3, SJR: 0.277, CiteScore: 0)
Anales de Pediatría (English Edition)     Full-text available via subscription  
Anales de Pediatría Continuada     Full-text available via subscription  
Analytic Methods in Accident Research     Hybrid Journal   (Followers: 5, SJR: 4.849, CiteScore: 10)
Analytica Chimica Acta     Hybrid Journal   (Followers: 44, SJR: 1.512, CiteScore: 5)
Analytica Chimica Acta : X     Open Access  
Analytical Biochemistry     Hybrid Journal   (Followers: 211, SJR: 0.633, CiteScore: 2)
Analytical Chemistry Research     Open Access   (Followers: 13, SJR: 0.411, CiteScore: 2)
Analytical Spectroscopy Library     Full-text available via subscription   (Followers: 14)
Anesthésie & Réanimation     Full-text available via subscription   (Followers: 2)
Anesthesiology Clinics     Full-text available via subscription   (Followers: 25, SJR: 0.683, CiteScore: 2)
Angiología     Full-text available via subscription   (SJR: 0.121, CiteScore: 0)
Angiologia e Cirurgia Vascular     Open Access   (Followers: 1, SJR: 0.111, CiteScore: 0)
Animal Behaviour     Hybrid Journal   (Followers: 227, SJR: 1.58, CiteScore: 3)
Animal Feed Science and Technology     Hybrid Journal   (Followers: 7, SJR: 0.937, CiteScore: 2)
Animal Reproduction Science     Hybrid Journal   (Followers: 7, SJR: 0.704, CiteScore: 2)

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Similar Journals
Journal Cover
American Journal of Medicine
Number of Followers: 50  
 
  Hybrid Journal Hybrid journal (It can contain Open Access articles)
ISSN (Print) 0002-9343 - ISSN (Online) 1555-7162
Published by Elsevier Homepage  [3182 journals]
  • SPLENIC INFARCTION: A DARK SIDE OF THE NEPHROTIC SYNDROME
    • Abstract: Publication date: Available online 9 November 2019Source: The American Journal of MedicineAuthor(s): Giuseppe Famularo, Andrea Cortese
       
  • The Quiet Hum: Pulmonary Arteriovenous Malformations and Hereditary
           Hemorrhagic Telangiectasia
    • Abstract: Publication date: Available online 9 November 2019Source: The American Journal of MedicineAuthor(s): Benjamin D. Fiore, Matthew C. Russell, Michael F. Powers, Janet N. Myers
       
  • Reversible cause of Neuropathy and Monoclonal Gammopathy Of Renal
           Significance
    • Abstract: Publication date: Available online 9 November 2019Source: The American Journal of MedicineAuthor(s): Garima Dabas, Tarun Narang, Rajesh Kumar, Ritambhra Nada, Sunil Dogra, Krishan Lal Gupta, Raja Ramachandran
       
  • Identifying Solutions to Ambulatory Faculty Recruitment, Retention, and
           Remuneration in Graduate Medical Education: an AAIM Position Paper
    • Abstract: Publication date: Available online 9 November 2019Source: The American Journal of MedicineAuthor(s): Margaret C. Lo, Jonathan Tolentino, Sara B. Fazio, Steve Vinciguerra, Alpesh N. Amin, Andrew Dentino, Susan T. Hingle, Kerri Palamara, Isitri Modak, Michael Kisielewski, John P. Moriarty
       
  • Parvovirus B19 Infection with Positive Rumpel-Leede Sign
    • Abstract: Publication date: Available online 9 November 2019Source: The American Journal of MedicineAuthor(s): Junki Mizumoto
       
  • Hyperphosphatemia and multiple myeloma: keep calm and control first
    • Abstract: Publication date: Available online 9 November 2019Source: The American Journal of MedicineAuthor(s): Charlotte Boud'hors, Morgane Le Gallo, Corentin Orvain, Françoise Larcher, Martine Gardembas, Jean-François Augusto, Julien Demiselle
       
  • A Fuzzy Cause of Hip Pain
    • Abstract: Publication date: Available online 9 November 2019Source: The American Journal of MedicineAuthor(s): David L. Leverenz, Lisa G. Criscione-Schreiber
       
  • Rigid ears and hyperpigmentation in Addison's disease
    • Abstract: Publication date: Available online 9 November 2019Source: The American Journal of MedicineAuthor(s): Ko Harada, Fumio Otsuka
       
  • A Latin American patient with a left ventricular pseudoaneurysm presenting
           with progressive dyspnea and palpitations
    • Abstract: Publication date: Available online 9 November 2019Source: The American Journal of MedicineAuthor(s): Andrés F. Henao-Martínez, Solana Archuleta, Daniel Vargas, Carlos Franco-Paredes
       
  • Etiologies of Thrombocytopenia in the Community Hospital: the Experience
           of One Hematologist
    • Abstract: Publication date: Available online 9 November 2019Source: The American Journal of MedicineAuthor(s): Michael Boxer, Thomas J. Biuso BackgroundThrombocytopenia in hospitalized patients is a common cause for hematologic consultation. Our experience in the community hospital setting can inform treating physicians of the causes for and need to treat thrombocytopenia. Here we describe our clinical experience from two community hospitals over a 22-month period, wherein a single hematologist was consulted for 97 cases of thrombocytopenia in 93 patients.MethodsReferred patients underwent history, physical, review of old records and imaging, relevant laboratory testing, review of the peripheral smear, and a bone marrow aspirate and biopsy if clinically indicated.ResultsThirty-five patients had a primary hematologic cause for their thrombocytopenia. Fifty-one had secondary causes for thrombocytopenia. Eleven patients had no discernible etiology for their thrombocytopenia. The most common hematologic diagnoses were immune thrombocytopenia (n=12), heparin-induced thrombocytopenia (n=6), platelet clumping (n=4), quite remarkably acute progranulocytic leukemia (n=4), and thrombotic thrombocytopenia purpura (n=3). The latter three were immediately diagnosed by reviewing the peripheral smear which led to appropriate therapy. The most common non-hematologic etiologies were liver disease (n=21), bacterial sepsis (n=12), and oral medication (n=7). Although the thrombocytopenia was mostly non-acute, immediate hematologic interventions were needed for 21 patients. Four patients died, none from complications of thrombocytopenia.ConclusionsThrombocytopenia in hospitalized patients requires consideration of multiple etiologies and review of the peripheral smear. Liver disease is often overlooked as a cause for thrombocytopenia.
       
  • Aspirin in the Treatment and Prevention of Migraine Headaches: Possible
           Additional Clinical Options for Primary Healthcare Providers
    • Abstract: Publication date: Available online 9 November 2019Source: The American Journal of MedicineAuthor(s): Bianca Biglione, Alexander Gitin, Philip B. Gorelick, Charles Hennekens Migraine headaches are among the most common and potentially debilitating disorders encountered by primary healthcare providers. In the treatment of acute migraine as well as prevention of recurrent attacks there are prescription drugs of proven benefit. For those without health insurance or high co-pays, however, they may be neither available nor affordable and, for all patients, they may be either poorly tolerated or contraindicated.The totality of evidence, which includes data from randomized trials, suggests that high-dose aspirin, in doses from 900 to 1300 milligrams, taken at the onset of symptoms, is an effective and safe treatment option for acute migraine headaches. In addition, the totality of evidence, including some, but not all, randomized trials, suggests the possibility that daily aspirin in doses from 81 to 325 milligrams, may be an effective and safe treatment option for the prevention of recurrent migraine headaches.The relatively favorable side effect profile of aspirin and extremely low costs compared with other prescription drug therapies may provide additional options for primary healthcare providers treating acute as well as recurrent migraine headaches.
       
  • Plasma Exchange Therapy in Postural Tachycardia Syndrome: A Novel
           Long-term Approach'
    • Abstract: Publication date: Available online 9 November 2019Source: The American Journal of MedicineAuthor(s): Rachel Wells, Pravin Hissaria, Adrian D. Elliott, Prashanthan Sanders, Amanda Page, Mathias Baumert, Dennis H Lau
       
  • An Evidence Based Review of Elevated Blood Pressure for the Inpatient
    • Abstract: Publication date: Available online 6 November 2019Source: The American Journal of MedicineAuthor(s): Bryan Stanistreet, Joseph A Nicholas, John D Bisognano Elevated blood pressure is common in hospitalized patients. There are no guidelines and few recommendations to help inpatient providers manage patients with elevated blood pressure. There are no normal reported values for blood pressure in the inpatient and recording circumstances often widely vary. Many factors may influence blood pressure such as pain, anxiety, malaise, nicotine withdrawal or with holding home medications. This review of available literature suggests potential harm and little to no potential benefit in treating asymptomatic patients with elevated blood pressure. This review also found no evidence that asymptomatic elevated blood pressure progresses to lead to end organ damage. However, there are clear instances of hypertensive emergency where treatment is indicated. Conscientious adjustment of an anti-hypertensive regimen should be undertaken during episode of elevated blood pressure associated with end organ damage.-Elevated blood pressure is common in hospitalized patients-Numerous factors can impact the blood pressure of an inpatient and there are no set standards for recording blood pressure in the inpatient.-There is no data that asymptomatic elevated blood pressure leads to end organ damage or hypertensive emergency.-Available literature suggests possible harm and little to no benefit in treating asymptomatic elevated blood pressure.
       
  • Chronic chikungunya arthritis and rheumatoid arthritis: what they have in
           common.
    • Abstract: Publication date: Available online 6 November 2019Source: The American Journal of MedicineAuthor(s): J. Kennedy Amaral, Joshua B. Bilsborrow, Robert T. Schoen Chikungunya virus (CHIKV) is a single-stranded RNA virus belonging to the family Togaviridae and genus Alphavirus, that causes an acute febrile illness, chikungunya fever, transmitted to humans by Aedes species mosquitoes. During acute illness, patients have high fever, polyarthralgias/polyarthritis, maculopapular rash, headache, and myalgia that lasts for days to weeks. Following resolution of acute infection, a significant proportion of patients develop chronic chikungunya arthritis that can resemble rheumatoid arthritis. In this review, we first consider the historical background of infectious causes of inflammatory arthritis, and then the pathogenic and clinical manifestations of chronic chikungunya arthritis as an rheumatoid arthritis mimic. We believe that chronic chikungunya arthritis may be a post-infectious, inflammatory process and that an understanding of the parallels and differences between chronic chikungunya arthritis and rheumatoid arthritis may offer insights into better diagnosis and treatment of both diseases.
       
  • The Reply
    • Abstract: Publication date: Available online 31 October 2019Source: The American Journal of MedicineAuthor(s): Aaron R. Folsom, Saonli Basu, Ching-Ping Hong, Susan R. Heckbert, Pamela L. Lutsey, Wayne D. Rosamond, Mary Cushman, for the Atherosclerosis Risk in Communities (ARIC) Study
       
  • Two Birds, One Stone–An Odd Case of Oligoarthritis
    • Abstract: Publication date: Available online 31 October 2019Source: The American Journal of MedicineAuthor(s): Oluseye Oduyale, Allison Bailey, James MacKenzie, Julius Oni, Sara Karaba, Martin Auster, Lucia Ponor
       
  • The Enduring and Practical Power of Physical Examination: Carnett Sign
    • Abstract: Publication date: Available online 31 October 2019Source: The American Journal of MedicineAuthor(s): Henry Schneiderman, Nerea Lopetegui-Lia, Julianne Nichols
       
  • Outcomes of Acute Myocardial Infarction in Patients with Influenza and
           Other Viral Respiratory Infections
    • Abstract: Publication date: October 2019Source: The American Journal of Medicine, Volume 132, Issue 10Author(s): Pimprapa Vejpongsa, Danai Kitkungvan, Mohammad Madjid, Konstantinos Charitakis, H. Vernon Anderson, Salman Arain, Prakash Balan, Richard W. Smalling, Abhijeet Dhoble BackgroundAcute influenza infection can trigger acute myocardial infarction, however, outcome of patients with acute myocardial infarction during influenza infection is largely unknown.MethodsPatients ≥ 18 years old with ST-elevation and non-ST-elevation myocardial infarction during January 2013-December 2014 were identified using the National Inpatient Sample. The clinical outcomes were compared among patients who had no respiratory infection to the ones with influenza and other viral respiratory infections using propensity score-matched analysis.ResultsOf 1,884,985 admissions for acute myocardial infarction, acute influenza and other viral infections were diagnosed in 9,885 and 11,485 patients, respectively, accounting for 1.1% of patients. Acute myocardial infarction patients with concomitant influenza infection had a worse outcome than those with acute myocardial infarction alone, in terms of in-hospital case fatality rate, development of shock, acute respiratory failure, acute kidney injury, and higher rate of blood transfusion after propensity scores. The length of stay is also significantly longer in influenza patients with acute myocardial infarction, compared with patients with acute myocardial infarction alone. However, patients who developed acute myocardial infarction during other viral respiratory infection have a higher rate of acute respiratory failure but overall lower mortality rate, and are less likely to develop shock or require blood transfusion after propensity match. Despite presenting with acute myocardial infarction, less than one-fourth of patients with concomitant influenza infection underwent coronary angiography, but more than half (51.4%) required revascularization.ConclusionInfluenza infection is associated with worse outcomes in acute myocardial infarction patients, and patients were less likely to receive further evaluation with invasive coronary angiography.
       
  • Otogenic Pneumocephalus Presenting as Pneumatocele of the Scalp
    • Abstract: Publication date: October 2019Source: The American Journal of Medicine, Volume 132, Issue 10Author(s): Mercy George, Vincent Dunet, Stephen Alzuphar, Francois Borsotti, Roy Thomas Daniel, Christian Simon
       
  • Don’t Trip Over the Trop: An Unusual Presentation of Thyrotoxic
           Periodic Paralysis
    • Abstract: Publication date: October 2019Source: The American Journal of Medicine, Volume 132, Issue 10Author(s): Norildin Al-Refaie, Shweta Appiah, Amit K.J. Mandal, Constantinos G. Missouris
       
  • Abnormal Chest Radiograph in Rapidly Progressive Glomerulonephritis—Not
           the Usual Pulmonary-Renal Syndrome
    • Abstract: Publication date: October 2019Source: The American Journal of Medicine, Volume 132, Issue 10Author(s): Jamie X.L. Kee, Jason C.J. Choo, Angela M. Takano, Syed S. Ahmed, Irene Y.J. Mok, Cynthia C. Lim
       
  • Keeping a Low Profile: Insulinoma
    • Abstract: Publication date: October 2019Source: The American Journal of Medicine, Volume 132, Issue 10Author(s): Ramzi Dudum, Vivek K. Murthy
       
  • Fish Oil and Cardiometabolic Diseases: Recent Updates and Controversies
    • Abstract: Publication date: October 2019Source: The American Journal of Medicine, Volume 132, Issue 10Author(s): Ramyashree Tummala, Raktim Kumar Ghosh, Vardhmaan Jain, Arvind Reddy Devanabanda, Dhrubajyoti Bandyopadhyay, Prakash Deedwania, Wilbert S. Aronow Fatty acids derived from fish oil are long-chain omega-3 (n-3) polyunsaturated fatty acids. The important polyunsaturated fatty acids of fish oil are eicosapentaenoic acid, and docosahexaenoic acid. For decades, there has been a debate about the use of omega-3 fatty acids and their benefits on cardiovascular health. The more recent trials including the JELIS, VITAL, STRENGTH, and ASCEND trials, addressed the paucity of data of omega-3 fatty acids on primary and secondary prevention of cardiovascular events and the risk-benefit balance of these supplements. Prior to these studies, many large randomized controlled trials have shown conflicting results on the effect of polyunsaturated fatty acids in patients with prior coronary artery disease, stroke, or major vascular events. These inconsistent results warrant a better understanding of the effects of omega-3 fatty acids on the subtypes of cardiovascular diseases, and their use in primary and secondary prevention. More recently, icosapent ethyl showed a significant reduction in cardiovascular mortality and ischemic events in patients with elevated triglyceride (TG) and established cardiovascular disease or diabetes. The REDUCE-IT trial paved the way to further reduce cardiovascular risk in patients with high TG despite being on a maximally tolerated statin. The aim of this review is to discuss these recent updates on the use of various forms of fish oil, including prescription form and supplement in cardiometabolic diseases, and their surrounding controversies.
       
  • Is It Possible to Make a Correct Diagnosis of Lyme Disease on Symptoms
           Alone' Review of Key Issues and Public Health Implications
    • Abstract: Publication date: October 2019Source: The American Journal of Medicine, Volume 132, Issue 10Author(s): Phillip J. Baker There is much confusion and misinformation about the diagnosis of Lyme disease, as well as its treatment. This review explains why one cannot make a correct diagnosis of Lyme disease based on symptoms alone. It also provides evidence to support the validity of two-tier testing for the laboratory diagnosis of Lyme disease. The public health consequences of failing to consider these issues are discussed.
       
  • A Clinical Approach to Diagnosing Encephalopathy
    • Abstract: Publication date: October 2019Source: The American Journal of Medicine, Volume 132, Issue 10Author(s): Michael G. Erkkinen, Aaron L. Berkowitz Encephalopathy refers to dysfunction of the level or contents of consciousness due to brain dysfunction and can result from global brain insults or focal lesions. The underlying causes of encephalopathy include both primary neurologic and systemic conditions. This article discusses the differential diagnosis of encephalopathy, with a focus on primary neurologic causes. A practical schema for organizing the differential diagnosis is to group etiologies by their pace of onset and evolution (eg, sudden, acute, subacute, chronic).
       
  • Peripheral Artery Disease: Past, Present, and Future
    • Abstract: Publication date: October 2019Source: The American Journal of Medicine, Volume 132, Issue 10Author(s): Umberto Campia, Marie Gerhard-Herman, Gregory Piazza, Samuel Z. Goldhaber Peripheral artery disease is a prevalent but underdiagnosed manifestation of atherosclerosis. There is insufficient awareness of its clinical manifestations, including intermittent claudication and critical limb ischemia and of its risk of adverse cardiovascular and limb outcomes. In addition, our inadequate knowledge of its pathophysiology has also limited the development of effective treatments, particularly in the presence of critical limb ischemia. This review aims to highlight essential elements of the epidemiology and pathophysiology of peripheral artery disease, bring attention to the often-atypical manifestations of occlusive arterial disease of the lower extremity, increase awareness of critical limb ischemia, briefly describe the diagnostic role of the ankle brachial index, and go over the contemporary management of peripheral artery disease. An emphasis is placed on evidence-based medical treatments to improve symptoms and quality of life and to reduce the risk of cardiovascular and limb events in these patients, including supervised exercise training, smoking cessation, antagonism of the renin-angiotensin system, lipid-lowering, antiplatelet, and antithrombotic therapies.
       
  • America’s Health Care System Is Broken: What Went Wrong and How We Can
           Fix It. Part 5: Malpractice, Fraud, Waste, and the EMR
    • Abstract: Publication date: October 2019Source: The American Journal of Medicine, Volume 132, Issue 10Author(s): Edward P. Hoffer Although the exact sums can only be estimated, large amounts of money are wasted by the US health care system through fraud and by spending on tests, procedures, and treatments that are of no proven benefit. The adversarial fault-finding malpractice system siphons off large amounts of money from patients to lawyers and legal costs and is a deterrent to system improvement. While electronic records have the potential to improve care and lower costs through information sharing, their current implementation neither improves care nor lowers costs. If care is to be improved while costs are reduced, changes must be made in all these areas.
       
  • Addendum to Dr. Robert Stern’s Commentary Concerning an Herbal Product
           that Relieved Neuropathic Pain in Several Patients
    • Abstract: Publication date: October 2019Source: The American Journal of Medicine, Volume 132, Issue 10Author(s): Joseph S. Alpert
       
  • Acute Herbal Therapy Efficacy: A Case Report
    • Abstract: Publication date: October 2019Source: The American Journal of Medicine, Volume 132, Issue 10Author(s): Robert G. Stern
       
  • Prevention of Statin Overtreatment and Increased Patient Compliance in
           High-Cardiovascular-Risk Individuals
    • Abstract: Publication date: October 2019Source: The American Journal of Medicine, Volume 132, Issue 10Author(s): David S. Schade, S. Scott Obenshain, R. Philip Eaton
       
  • Obscured in Transparency: Health Care Quality and Hospital Price
           Disclosure
    • Abstract: Publication date: October 2019Source: The American Journal of Medicine, Volume 132, Issue 10Author(s): Michael U. Antonucci
       
  • Type 2 Myocardial Infarction and Value-Based Programs: Cutting the Supply
           in the Absence of Demand
    • Abstract: Publication date: October 2019Source: The American Journal of Medicine, Volume 132, Issue 10Author(s): Cian P. McCarthy
       
  • Syncope in the Elderly
    • Abstract: Publication date: October 2019Source: The American Journal of Medicine, Volume 132, Issue 10Author(s): Joseph S. Alpert
       
  • 'Then Came the Measles': Tom Sawyer’s Rubeola Infection
    • Abstract: Publication date: October 2019Source: The American Journal of Medicine, Volume 132, Issue 10Author(s): Leonard J. Hoenig
       
  • E-Cigarettes and Methemoglobinemia: A Wolf in Sheep’s Clothing
    • Abstract: Publication date: October 2019Source: The American Journal of Medicine, Volume 132, Issue 10Author(s): Kamal Kant Sahu, Amos Lal, Ajay Kumar Mishra, Shamendra Anand Sahu
       
  • The Reply
    • Abstract: Publication date: October 2019Source: The American Journal of Medicine, Volume 132, Issue 10Author(s): Jonathan Myers, Peter Kokkinos
       
  • Invest in METs, Not in Meds
    • Abstract: Publication date: October 2019Source: The American Journal of Medicine, Volume 132, Issue 10Author(s): Jonida Haxhi, Stefano Balducci, Giuseppe Pugliese
       
  • The Reply
    • Abstract: Publication date: October 2019Source: The American Journal of Medicine, Volume 132, Issue 10Author(s): David J. Graham, Elande Baro, Michael Wernecke, Jeffrey A. Kelman
       
  • Appropriate Interpretation of the Observed NOACs Treatment Effect Size in
           Real-world Study
    • Abstract: Publication date: October 2019Source: The American Journal of Medicine, Volume 132, Issue 10Author(s): Yang Wang, Tao Chen, James Dodd, Wei Li
       
  • The Reply
    • Abstract: Publication date: October 2019Source: The American Journal of Medicine, Volume 132, Issue 10Author(s): Vida Abedi, Ramin Zand
       
  • Machine Learning and Patient Expectations: Potential Point of Disconnect
    • Abstract: Publication date: October 2019Source: The American Journal of Medicine, Volume 132, Issue 10Author(s): Amos Lal, Ajay Kumar Mishra, Kamal Kant Sahu, George M. Abraham
       
  • The Reply
    • Abstract: Publication date: October 2019Source: The American Journal of Medicine, Volume 132, Issue 10Author(s): Christel Renoux, Laurent Azoulay, Sophie Dell’Aniello, Oriana Hoi Yun Yu
       
  • The Reply
    • Abstract: Publication date: October 2019Source: The American Journal of Medicine, Volume 132, Issue 10Author(s): David Alfandre, Cynthia Geppert
       
  • Sharing Stories, Searching for Solutions: Sexual Harassment of Physicians
           by Patients
    • Abstract: Publication date: October 2019Source: The American Journal of Medicine, Volume 132, Issue 10Author(s): Shirin Hemmat, Elaine C. Khoong, Anjana E. Sharma, Urmimala Sarkar
       
  • Tackling the Problem of Ambulatory Faculty Recruitment in Undergraduate
           Medical Education: An AAIM Position Paper
    • Abstract: Publication date: October 2019Source: The American Journal of Medicine, Volume 132, Issue 10Author(s): Sara B. Fazio, Amy W. Shaheen, Alpesh N. Amin
       
  • Fulminant Human Granulocytic Anaplasmosis after CABG: An Unusual
           Occurrence
    • Abstract: Publication date: October 2019Source: The American Journal of Medicine, Volume 132, Issue 10Author(s): Brian Kim, Osamudiamen Idahosa, Jeffrey A. Jahre
       
  • Eosinophilic Granulomatosis With Polyangiitis: Histopathological
           Confirmation Despite Negative Serology
    • Abstract: Publication date: October 2019Source: The American Journal of Medicine, Volume 132, Issue 10Author(s): Anusha M. Kumar, Gordon H. Bae, Justin Besen, Bernice Y. Kwong, Kerri E. Rieger
       
  • A Case Report of Afebrile Malaria
    • Abstract: Publication date: October 2019Source: The American Journal of Medicine, Volume 132, Issue 10Author(s): Nima Madanchi, Rukma Govindu, Hussam Ammar
       
  • A Challenge Is Brewing: False-Positive Urine Alcohol in an Elderly
           Diabetic Male
    • Abstract: Publication date: October 2019Source: The American Journal of Medicine, Volume 132, Issue 10Author(s): Saif M. Borgan, Kirolus Sourial, Ernesto Robalino, Kathlyn Camargo, Minh Ho
       
  • Bony Bump of the Oral Cavity
    • Abstract: Publication date: October 2019Source: The American Journal of Medicine, Volume 132, Issue 10Author(s): Sarah Soon Khe Wei, Ranjeet Bapat, Tanay Chaubal
       
  • An Electrocardiogram-Based Diagnosis of Coma
    • Abstract: Publication date: October 2019Source: The American Journal of Medicine, Volume 132, Issue 10Author(s): Camille Simard, Blair Carl Schwartz
       
  • Severe Metastatic Pulmonary Calcification
    • Abstract: Publication date: October 2019Source: The American Journal of Medicine, Volume 132, Issue 10Author(s): Masaya Taniwaki, Kazuma Kawamoto, Masahiro Yamasaki, Kunihiko Funaishi, Yu Matsumoto, Naoko Matsumoto, Nobuyuki Ohashi, Noboru Hattori
       
  • Chronic Kidney Disease in Agricultural Communities
    • Abstract: Publication date: October 2019Source: The American Journal of Medicine, Volume 132, Issue 10Author(s): Russell A. Wilke, Mohammad Qamar, Roxana A. Lupu, Shaopeng Gu, Jing Zhao Patients residing in agricultural communities have a high risk of developing chronic kidney disease. In the Great Plains, geo-environmental risk factors (eg, variable climate, temperature, air quality, water quality, and drought) combine with agro-environmental risk factors (eg, exposure to fertilizers, soil conditioners, herbicides, fungicides, and pesticides) to increase risk for toxic nephropathy. However, research defining the specific influence of agricultural chemicals on the progression of kidney disease in rural communities has been somewhat limited. By linking retrospective clinical data within electronic medical records to environmental data from sources like US Environmental Protection Agency, analytical models are beginning to provide insight into the impact of agricultural practices on the rate of progression for kidney disease in rural communities.
       
  • Case Reports in the Age of Twitter
    • Abstract: Publication date: October 2019Source: The American Journal of Medicine, Volume 132, Issue 10Author(s): Adam S. Cifu, Andrae L. Vandross, Vinay Prasad
       
  • Leisure-Time Running Reduces the Risk of Incident Type 2 Diabetes
    • Abstract: Publication date: October 2019Source: The American Journal of Medicine, Volume 132, Issue 10Author(s): Yuehan Wang, Duck-chul Lee, Angelique G. Brellenthin, Thijs M.H. Eijsvogels, Xuemei Sui, Timothy S. Church, Carl J. Lavie, Steven N. Blair ObjectivesWe examined the overall association as well as the dose–response relationship between leisure-time running and incident type 2 diabetes.MethodsParticipants were 19,347 adults aged 18-100 years who were free of cardiovascular disease, cancer, and diabetes at baseline, and who received at least 2 extensive preventive medical examinations between 1974 and 2006. Running and other types of aerobic physical activity were assessed by self-reported leisure-time activities. Type 2 diabetes was defined as fasting glucose ≥ 126 mg/dL (7.0 mmol/L), physician diagnosis, or insulin use.ResultsDuring an average follow-up of 6.5 years, 1015 adults developed type 2 diabetes. Approximately 29.5% of adults participated in leisure-time running at baseline. Runners had a 28% (hazard ratio [HR] 0.72; 95% confidence interval [CI], 0.62-0.84) lower risk of developing type 2 diabetes compared with nonrunners during follow-up. The HRs (95% CIs) of type 2 diabetes were 0.98 (0.75-1.28), 0.69 (0.51-0.92), 0.62 (0.45-0.85), 0.78 (0.59-1.04), and 0.57 (0.42-0.79) across quintiles of running time (minutes/week) compared with nonrunners after adjusting for potential confounders, including levels of nonrunning aerobic physical activity. Similar dose–response relationships between running distance (miles/week), frequency (times/week), total amount (MET-minutes/week), and speed (mph) were also observed.ConclusionsParticipating in leisure-time running is associated with a lower risk of developing type 2 diabetes in adults. Consistent linear dose–response relationships were observed between various running parameters and incident type 2 diabetes, supporting the prescription of running to prevent type 2 diabetes.
       
  • Walking Speed Drives the Prognosis of Older Adults with Cardiovascular and
           Neuropsychiatric Multimorbidity
    • Abstract: Publication date: October 2019Source: The American Journal of Medicine, Volume 132, Issue 10Author(s): Davide L Vetrano, Debora Rizzuto, Amaia Calderón-Larrañaga, Graziano Onder, Anna-Karin Welmer, Chengxuan Qiu, Roberto Bernabei, Alessandra Marengoni, Laura Fratiglioni BackgroundWe investigated the impact of multiple cardiovascular and neuropsychiatric diseases on all-cause and cause-specific mortality in older adults, considering their functional status.MethodsThis cohort study included 3241 participants (aged ≥ 60 years) in the Swedish National study of Aging and Care in Kungsholmen (SNAC-K). Number of cardiovascular and neuropsychiatric diseases was categorized as 0, 1, or ≥ 2. Functional impairment was defined as walking speed of
       
  • Digoxin Use and Associated Adverse Events Among Older Adults
    • Abstract: Publication date: October 2019Source: The American Journal of Medicine, Volume 132, Issue 10Author(s): Suveen Angraal, Sudhakar V. Nuti, Frederick A. Masoudi, James V. Freeman, Karthik Murugiah, Nilay D. Shah, Nihar R. Desai, Isuru Ranasinghe, Yun Wang, Harlan M. Krumholz BackgroundOver the past 2 decades, guidelines for digoxin use have changed significantly. However, little is known about the national-level trends of digoxin use, hospitalizations for toxicity, and subsequent outcomes over this time period.MethodsTo describe digoxin prescription trends, we conducted a population-level, cohort study using data from IQVIA, Inc.’s National Prescription Audit (2007-2014) for patients aged ≥ 65 years. Further, in a national cohort of Medicare fee-for-service beneficiaries aged ≥ 65 years in the United States, we assessed temporal trends of hospitalizations associated with digoxin toxicity and the outcomes of these hospitalizations between 1999 and 2013.ResultsFrom 2007 through 2014, the number of digoxin prescriptions dispensed decreased by 46.4%; from 8,099,856 to 4,343,735. From 1999 through 2013, the rate of hospitalizations with a principal or secondary diagnosis of digoxin toxicity decreased from 15 to 2 per 100,000 person-years among Medicare fee-for-service beneficiaries. In-hospital and 30-day mortality rates associated with hospitalization for digoxin toxicity decreased significantly among Medicare fee-for-service beneficiaries; from 6.0% (95% confidence interval [CI], 5.2-6.8) to 3.7% (95% CI, 2.2-5.7) and from 14.0% (95% CI, 13.0-15.2) to 10.1% (95% CI, 7.6-13.0), respectively. Rates of 30-day readmission for digoxin toxicity decreased from 23.5% (95% CI, 22.1-24.9) in 1999 to 21.7% (95% CI, 18.0-25.4) in 2013 (P < .05).ConclusionWhile digoxin prescriptions have decreased, it is still widely prescribed. However, the rate of hospitalizations for digoxin toxicity and adverse outcomes associated with these hospitalizations have decreased. These findings reflect the changing clinical practice of digoxin use, aligned with the changes in clinical guidelines.
       
  • “The Importance of Hanging in There”
    • Abstract: Publication date: Available online 31 October 2019Source: The American Journal of MedicineAuthor(s): Joseph A. Carrese
       
  • Wither away: Weight loss and persistent inflammation in a woman with
           Whipple's disease
    • Abstract: Publication date: Available online 31 October 2019Source: The American Journal of MedicineAuthor(s): Max J. Schunemann, Jürg Vosbeck, Kwadwo Antwi, Stefano Bassetti, Michael Osthoff
       
  • Uncertain aetiology of left ventricular hypertrophy in a young subject
           with hypertension treated with dexamphetamine
    • Abstract: Publication date: Available online 28 October 2019Source: The American Journal of MedicineAuthor(s): F Morselli, L Fang, I Ambrosini, P J Chowienczyk, L Faconti
       
  • Outcomes of takotsubo syndrome at 15 years: A matched cohort study
    • Abstract: Publication date: Available online 24 October 2019Source: The American Journal of MedicineAuthor(s): Nathalie Auger, Gilles Paradis, Jessica Healy-Profitós, Siyi He, Brian J. PotterABSTRACTBackgroundThe association of takotsubo syndrome with future risk of cardiovascular and noncardiovascular morbidity and mortality is unclear. We assessed the long-term risk of morbidity and mortality in patients with takotsubo syndrome.MethodsWe performed a matched cohort study of 174 patients with takotsubo syndrome between 1989 and 2006 in Quebec, Canada, with 15 years of follow-up on future hospitalization outcomes. We matched takotsubo patients to two comparison groups, including 1,736 patients with acute myocardial infarction and 1,740 population controls. We estimated hazard ratios (HR) and 95% confidence intervals (CI) for the association of takotsubo syndrome with subsequent in-hospital mortality, cardiovascular morbidity, and other hospitalization outcomes.ResultsDuring 15 years of follow-up, patients with takotsubo syndrome had a similar risk of in-hospital mortality as patients with myocardial infarction (HR 1.06, 95% CI 0.81-1.38), but a lower risk of cardiovascular rehospitalization (HR 0.79, 95% CI 0.66-0.95). Compared with population controls, however, takotsubo was associated with 1.59 times the risk of in-hospital mortality (95% CI 1.21-2.09), 2.71 times the risk of cardiovascular rehospitalization (95% CI 2.24-3.28), and 1.86 times the risk of hospitalization for stress and anxiety disorders (95% CI 1.21-2.85). Associations were significantly stronger the first few years after the initial admission for takotsubo, and weakened over time.ConclusionsTakotsubo syndrome is associated with a similar risk of mortality as myocardial infarction after 15 years, but a lower risk of cardiovascular rehospitalization. Patients with takotsubo syndrome nonetheless have more in-hospital mortality and cardiovascular morbidity than population controls.
       
  • The American Health Care System is Broken. Part 7: How Can We Fix It'
    • Abstract: Publication date: Available online 24 October 2019Source: The American Journal of MedicineAuthor(s): Edward P Hoffer Previous articles have outlined the many problems that confront America in trying to humanely and efficiently deliver health care to our citizens. First among these is that health care is unaffordable for too many. This final paper describes how to expand coverage to all Americans and identifies many specific areas where changes can be made to both improve care and lower costs.  There are many ways to reduce the cost of medications, to improve hospital care while lowering costs, to eliminate “surprise medical bills,” and to cut down fraud and waste. The socioeconomic factors that contribute heavily to our poor health outcomes must be addressed.
       
  • Blue Toes at High Altitude: Peripheral Cyanosis
    • Abstract: Publication date: Available online 24 October 2019Source: The American Journal of MedicineAuthor(s): Amol Gupta, Ravi Gupta, Vinod Kumar, Samir Samarany
       
  • #StoptheRobbery: How residency training programs can help
    • Abstract: Publication date: Available online 23 October 2019Source: The American Journal of MedicineAuthor(s): Kruti J. Yagnik, Ashleigh Wright, Zareen Zaidi
       
  • Cardiovascular and Cerebrovascular Safety of Testosterone Therapy
    • Abstract: Publication date: Available online 21 October 2019Source: The American Journal of MedicineAuthor(s): Abdulmaged M. Traish, Geoffrey Hackett, Martin Miner, Abraham Morgentaler
       
  • Massive Pulmonary Artery Dilatation in a Case of Chronic Thromboembolic
           Pulmonary Hypertension
    • Abstract: Publication date: September 2019Source: The American Journal of Medicine, Volume 132, Issue 9Author(s): Jeremy A. Miles, Ningxin Wan, Sandhya Murthy
       
  • Following the Track to an Unexpected Diagnosis: Phaeohyphomycosis
    • Abstract: Publication date: September 2019Source: The American Journal of Medicine, Volume 132, Issue 9Author(s): Arooj Mohammed, Sahand Rahnama-Moghadam
       
  • Mucormycosis: More Than Meets the Eye!
    • Abstract: Publication date: September 2019Source: The American Journal of Medicine, Volume 132, Issue 9Author(s): Maryann T. Ally, Ian H. Jenkins, Vineet Gupta
       
  • Thrombotic Thrombocytopenic Purpura: Beyond Empiricism and Plasma Exchange
    • Abstract: Publication date: September 2019Source: The American Journal of Medicine, Volume 132, Issue 9Author(s): Han-Mou Tsai For many years after its first description in 1924, thrombotic thrombocytopenic purpura was an intriguing puzzle for clinicians and researchers, not only for its unique pathology, perplexing changes in von Willebrand factor multimers, and high rate of rapid fatality but also for its dramatic response to plasma infusion or exchange. The discovery of ADAMTS13 (a disintegrin and metalloprotease with thrombospondin type 1 repeats member-13) and its deficiency in patients with thrombotic thrombocytopenic purpura, due to inhibitory autoantibodies or genetic mutations, provides a mechanistic scheme for understanding its pathogenesis. This new knowledge quickly led to the use of rituximab to promote its remission and prevent recurrence. Recombinant ADAMTS13 is also under development to replace plasma infusion as the therapy for hereditary thrombotic thrombocytopenic purpura. Recently, caplacizumab, a bivalent nanobody targeting the glycoprotein 1b binding epitope of von Willebrand factor A1 domain, was approved as an addition to the current regimen of plasma exchange and immunomodulation for adult patients of acquired thrombotic thrombocytopenic purpura. This review discusses how the new treatment may improve patient outcomes and its potential pitfalls.
       
  • What Clinicians Need to Know About the Cardiovascular Effects of the Most
           Recent Classes of Drugs Used for Type 2 Diabetes
    • Abstract: Publication date: September 2019Source: The American Journal of Medicine, Volume 132, Issue 9Author(s): Richard A. Ferraro, Caitlin M. Nass, Ramzi Dudum, Roger S. Blumenthal, Sudipa Sarkar The treatment of cardiovascular disease in patients with diabetes has seen a sea change in recent years with the development of novel antihyperglycemic agents. The impact of sodium-glucose cotransporter-2 (SGLT2) inhibitors and glucagon-like peptide-1 receptor agonists (GLP-1 RAs), two medication classes introduced in the United States in the wake of increased scrutiny by the US Food and Drug Administration on cardiovascular disease and antihyperglycemic agents, highlight this progression. In recent trials, SGLT2 inhibitors have demonstrated significant reductions in admissions for heart failure in patients with established cardiovascular disease and those at risk of cardiovascular disease, as well as significant reductions in major adverse cardiovascular events for those with established cardiovascular disease. GLP-1 RAs have exhibited consistent reductions in major adverse cardiovascular events for patients with established cardiovascular disease. These developments have led the 2019 American Diabetes Association guidelines to recommend considering each patient’s cardiovascular history when selecting antihyperglycemic agents. The goal of this article is to review recent updates and provide relevant strategies for providers on SGLT2 and GLP-1 RAs in treating cardiovascular disease in patients with diabetes.
       
  • Concepts and Techniques in Postbariatric Body Contouring: A Primer for the
           Internist
    • Abstract: Publication date: September 2019Source: The American Journal of Medicine, Volume 132, Issue 9Author(s): Philip Lotfi, Ryan Engdahl Following weight loss after bariatric surgery, many people seek body contouring to help with troublesome excess skin. The care of these patients frequently involves a primary practitioner. Understanding the basic concepts of body contouring can help patients with these disorders. We review commonly performed body-contouring procedures that treat excess skin of the abdomen, arms, and thighs in the patient experiencing massive weight loss postbariatric procedures. Key concepts and techniques are highlighted with visual aids to help with understanding.
       
  • America’s Health Care System is Broken: What Went Wrong and How We Can
           Fix It. Part 4: The Pharmaceutical Industry
    • Abstract: Publication date: September 2019Source: The American Journal of Medicine, Volume 132, Issue 9Author(s): Edward P. Hoffer As is true for most aspects of the US health care system, we pay much more for medications than do patients in any other country. Not only are new “breakthrough” products expensive, but existing products see price increases that regularly outstrip general inflation, making the pharmaceutical industry very profitable and resulting in many patients skipping or cutting the doses of such critical medicines as insulin. There is little relation between the effectiveness and the price of many medications. Drug firms like to cite the high cost of research and development but spend more on marketing than on research and development. The firms also spend large sums on lobbying and to influence medical thought leaders to keep their profits high. We are alone in spending billions of dollars on pharmacy benefit managers that add little value. With new gene-based therapies on the horizon, the price of therapeutics may be unsustainable.
       
  • Further Turns in the Conception and Regulation of Physician-Assisted Dying
           in the Netherlands
    • Abstract: Publication date: September 2019Source: The American Journal of Medicine, Volume 132, Issue 9Author(s): Jacob J.E. Koopman
       
  • Gene-Based Prescribing Is Here. Are Providers Ready'
    • Abstract: Publication date: September 2019Source: The American Journal of Medicine, Volume 132, Issue 9Author(s): Leland E. Hull, Lisa Soleymani Lehmann, Julie A. Lynch
       
  • Aspirin for the Primary Prevention of Cardiovascular Disease: Weighing Up
           the Evidence
    • Abstract: Publication date: September 2019Source: The American Journal of Medicine, Volume 132, Issue 9Author(s): Sean Murphy, Cian P. McCarthy, John W. McEvoy
       
  • Lack of Measles Vaccination of a Few Portends Future Epidemics and
           Vaccination of Many
    • Abstract: Publication date: September 2019Source: The American Journal of Medicine, Volume 132, Issue 9Author(s): Rachael Silverberg, Jennifer Caceres, Sara Greene, Mark Hart, Charles H. Hennekens
       
  • Placebo and Nocebo Effects, Medication Bias, and Hearsay
    • Abstract: Publication date: September 2019Source: The American Journal of Medicine, Volume 132, Issue 9Author(s): Joseph S. Alpert
       
  • Prognostic Significance of Longitudinal Clinical Congestion Pattern in
           Chronic Heart Failure: Insights From TIME-CHF Trial
    • Abstract: Publication date: September 2019Source: The American Journal of Medicine, Volume 132, Issue 9Author(s): Justas Simonavičius, Sandra Sanders van-Wijk, Peter Rickenbacher, Micha T. Maeder, Otmar Pfister, Beat A. Kaufmann, Matthias Pfisterer, Jelena Čelutkienė, Roma Puronaitė, Christian Knackstedt, Vanessa van Empel, Hans-Peter Brunner-La Rocca BackgroundThe relationship between longitudinal clinical congestion pattern and heart failure outcome is uncertain. This study was designed to assess the prevalence of congestion over time and to investigate its impact on outcome in chronic heart failure.MethodsA total of 588 patients with chronic heart failure older than 60 years of age with New York Heart Association (NYHA) functional class ≥ II from the TIME-CHF study were included. The endpoints for this study were survival and hospitalization-free heart failure survival. Orthopnea, NYHA ≥ III, paroxysmal nocturnal dyspnea, hepatomegaly, peripheral pitting edema, jugular venous distension, and rales were repeatedly investigated and related to outcomes. These congestion-related signs and symptoms were used to design a 7-item Clinical Congestion Index.ResultsSixty-one percent of patients had a Clinical Congestion Index ≥ 3 at baseline, which decreased to 18% at month 18. During the median [interquartile range] follow-up of 27.2 [14.3-39.8] months, 17%, 27%, and 47% of patients with baseline Clinical Congestion Index of 0, 1-2, and ≥ 3 at inclusion, respectively, died (P
       
  • Needle in a Haystack: A Missed Case of Wound Botulism
    • Abstract: Publication date: September 2019Source: The American Journal of Medicine, Volume 132, Issue 9Author(s): Andi Hudler, Matthew Cataldo, Ajay Major, Ingrid Lobo
       
  • Recognizing Central Nervous System Involvement as a Progressive Feature of
           Microscopic Polyangiitis: A Diagnostic Dilemma
    • Abstract: Publication date: September 2019Source: The American Journal of Medicine, Volume 132, Issue 9Author(s): Tawnya Pancharovski, Saikrishna Patibandla, Aung Naing Lin, Ying Xian Liu, Stuart Green, Sima S. Pendharkar
       
  • Cardiorespiratory Fitness and Health Care Costs in Diabetes: The Veterans
           Exercise Testing Study
    • Abstract: Publication date: September 2019Source: The American Journal of Medicine, Volume 132, Issue 9Author(s): Jonathan Myers, Christina Grüne de Souza e Silva, Rachelle Doom, Holly Fonda, Khin Chan, Shirit Kamil-Rosenberg, Peter KokkinosABSTRACTBACKGROUNDThis study aimed to determine the association between cardiorespiratory fitness and healthcare expenditures among individuals with and without diabetes.MethodsHealth care costs were quantified among 3924 consecutive men (mean age 58 ± 11 years) referred for a maximal exercise test, and compared according to presence (n = 2457) and absence (n = 1467) of diabetes and fitness. Fitness was classified into 4 categories based on age-stratified quartiles of peak metabolic equivalents: least-fit (5.1 ± 1.5 metabolic equivalents; n = 1044), moderately-fit (7.6 ± 1.5 metabolic equivalents; n = 938), fit (9.4 ± 1.5 metabolic equivalents; n = 988), and highly-fit (12.4 ± 2.2 metabolic equivalents; n = 954). Annual costs per subject were quantified over an 8-year period.ResultsAge, BMI, and presence of cardiovascular disease (CVD) were similar between subjects with and without diabetes. After adjusting for age and presence of CVD, annual costs per person were higher among diabetics vs. non-diabetics. Individuals with and without diabetes in the highly-fit category had annual costs (US dollars x 103) (mean ± standard deviation) that were on average $32,178 and $30,816 lower, respectively, than individuals in the least-fit category. For each 1-metabolic equivalent higher fitness, annual cost savings per person were $5,193 and $3,603 for individuals with and without diabetes, respectively.ConclusionsHigher fitness is associated with lower health care costs. Cost savings associated with higher fitness are particularly evident among individuals with diabetes. The economic burden of diabetes may be reduced through interventions that target improvements in fitness.
       
 
 
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